labor_case_study - Labor Case Study Labor Case Study...

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Labor Case Study Labor Case Study Scenario You are the charge nurse working in labor and delivery at a local hospital. D.H. comes to the unit having contractions and feeling somewhat uncomfortable. You take her to the intake room to provide privacy, have her change into a gown, and ask her 3 initial questions to determine your next course of action, that is, whether to do a vaginal exam or to continue asking her more questions. 1. What three initial questions should you ask and why? We should ask what the contractions feel like to determine if they are Braxton Hicks or true contractions, how many weeks gestation she is to determine if it is normal contractions occurring, or if there may be a possible complication, and when and if prenatal care was started to determine any electrolyte or other nutrient imbalances. 2. D.H. has contractions 2 to 3 minutes apart and lasting 45 seconds. It is her third pregnancy (gravida 3, para 2002). Her bag of waters (BOW) is intact at this time. You determine it is appropriate to ask for further information before doing a vaginal exam. What information do you need? Does she have any specific plans for this labor and delivery, such as who is allowed to be in the room or come for visits, lighting, atmosphere, use of pain medications, etc. We also need to ask if there were any other complications during her previous labor and deliveries. Were any of her other children born by c-section? Did she need to be induced in the past? What is the average weight of her previous babies? Does she usually delivery pre-term, term, or late-term? How long did her previous labor and deliveries usually take with her first two children? 3. What assessment should you make to gain further information from D.H.? We should determine whether the baby is cephalic or in a breech position. We need to determine mom’s pelvic shape, and possibly do an ultrasound to determine a possible weight of the baby and if it will be able to pass through the pelvis, or if it will be too big. We need to do a vaginal exam to find out if she is effaced at all and if she is dilated. A pain assessment should be done to
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determine if mom wants to use medications at all, and if it is still possible at this stage of labor, however far along she may be. 4. You check D.H.; she is 80% effaced and 4 cm dilated. The fetal heart rate (FHR) is 150 beats/min and regular. She is admitted to a labor and delivery room on the unit. What nursing measures should be done at this time? At this time, unless there are other complications, it is just a waiting game until she is 100% effaced and 10 cm dilated and ready to push. We should be performing comfort measures for mom, assessing pain and determining if there is anything we can do or give her at this stage in labor. We need to be assessing
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